Benzodiazipine Requests for Non Clinical Needs

We are occasionally asked by patients to prescribe sedating medication for flying, procedures, or other non-clinical reasons.

We regret that henceforth we are not able to facilitate these requests on the grounds of patient safety and our need to prioritise the delivery of NHS care on the basis of patients’ clinical needs.

We have outlined below further information regarding our practice decision to refuse prescribing for these reasons.

Flying:

Sedating medication, e.g. benzodiazepines such as diazepam, can render someone either paradoxically aggressive, or less able to follow instructions in an emergency, thus putting crew and other passengers at risk.

Sleeping tablets similarly have no indication for flying, and again could make a passenger difficult to rouse or transfer if there was a genuine in-flight emergency. Often passengers mix these medications with alcohol, with deleterious consequences. We would not wish you to to be barred from a flight or face prosecution, or find yourself incapacitated due to the unpredictable effects of said medication. The drug driving legislation which came into effect in recent years would also potentially prohibit onward driving from an airport.

Flight anxiety should be treated by Cognitive Behavioural Therapy – a form of counselling, which has long lasting benefits and is safe. Airline carriers offer excellent courses for free, so do speak with your flight provider to arrange to go on a course well in advance of when you know you will be flying.

We acknowledge there may be occasion when you have previously received a prescription for this purpose. We regret that we will be unable to agree to such requests henceforth. This is a joint decision, unanimously made by all senior clinical staff within the practice.

Patients are reminded that they are able to arrange a consultation at a private travel clinic should they wish to pursue the option of in-flight medication further, but we cannot accommodate their request.

Appointments, including Procedures and Dental Appointments:

Small doses of benzodiazepines such at 2mg diazepam are probably sub-therapeutic for most adults for any effective sedation. Conversely anxiolytics can have an idiosyncratic response in patients, and even very small doses can cause increased agitation in some subsets of patients.

A patient may take a sedative ‘an hour’ before their assumed procedure, to then attend the hospital to find their procedure has been delayed, therefore the timing of the anxiolytic being sub optimal.

GPs are not regularly involved, skilled, trained or appraised in sedation skills.

All hospital consultants, and dentists have access to the same prescribing abilities as GPs. If a patient needs a certain medication to enable an investigation/appointment to go ahead, they are just as well positioned to provide a prescription.

Sedated patients should be regularly monitored, and this cannot be organised through the GP.

We maintain that we are not being ‘obstructive’ but adhering to our duty of care to provide safe, consistent, and appropriate care for our patients. We have the full support of our statutory representative body, Cambs LMC, in this position. We apologise for any inconvenience this may cause.